ECCO Review Outlines Diagnosis and Management of Drug-Induced Enterocolitis

An ECCO multidisciplinary panel reviewed the literature and agreed on 23 practice positions for drug-induced enterocolitis, with a focus on immune checkpoint inhibitor-related disease. The positions cover diagnostic assessment, treatment escalation and decisions about immunotherapy rechallenge.

Twenty-three ECCO practice positions were agreed upon.
Drug-related histological patterns are not disease-specific.
Work-up includes pathogen testing and endoscopy with biopsies.
Escalation options include infliximab or vedolizumab.

Drug-induced enterocolitis can resemble inflammatory bowel disease clinically, endoscopically and histologically. A multidisciplinary panel convened by the European Crohn’s and Colitis Organisation systematically reviewed the literature and developed 23 consensus-based Current Practice Positions on diagnostic principles, histopathological patterns and treatment, with particular attention to immune checkpoint inhibitor (ICI)-induced enterocolitis.

The review describes several possible histological patterns, including IBD-like or chronic enterocolitis, acute enterocolitis, microscopic colitis and ischemic-type injury; none is considered pathognomonic. For suspected ICI-induced disease, the positions call for severity grading, stool pathogen testing, fecal calprotectin and endoscopy with biopsies, with imaging when indicated. Corticosteroids are described as first-line treatment; mild or microscopic disease may respond to budesonide or beclomethasone. In corticosteroid-refractory or corticosteroid-dependent cases, early escalation to infliximab or vedolizumab is advised. ICI rechallenge may be considered after multidisciplinary evaluation.

These positions offer a practical framework for a diagnostically complex toxicity, but the source is a literature review and structured consensus, not a comparative treatment trial. The abstract does not provide evidence grades or detailed recommendations for individual clinical scenarios.

In practice

For patients with suspected immune checkpoint inhibitor-induced enterocolitis, the ECCO positions support assessment of severity, stool testing for pathogens, fecal calprotectin and endoscopy with biopsies, with imaging when indicated. Corticosteroids are first-line in the review; budesonide or beclomethasone may be options for mild or microscopic disease, while corticosteroid-refractory or dependent disease should prompt consideration of early infliximab or vedolizumab escalation. These are consensus positions based on a literature review, not comparative trial results; ICI rechallenge requires multidisciplinary evaluation.

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Source

Journal of Crohn's and Colitis: ECCO Topical Review: Inflammatory Bowel Disease-Like Patterns of Drug Colitis with Practical Guidance and a Focus on Immune Checkpoint Inhibitor-Induced Enterocolitis ↗

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